Early cerebral hypoxia in extremely preterm infants and neurodevelopmental impairment at 2 year of age: A post hoc analysis of the SafeBoosC II trial

• Published in: PloS one 2022-01, Vol.17 (1), p.e0262640-e0262640
• Main Authors: Plomgaard, Anne Mette, Schwarz, Christoph E, Claris, Olivier, Dempsey, Eugene M, Fumagalli, Monica, Hyttel-Sorensen, Simon, Lemmers, Petra, Pellicer, Adelina, Pichler, Gerhard, Greisen, Gorm
• Format: Article
• Language: English
• Subjects: Age; Babies; Biology and Life Sciences; Biomarkers; Cerebral ischemia; Cerebral palsy; Child development deviations; Child, Preschool; Cognitive ability; Complications and side effects; Developmental disabilities; EEG; Female; Health aspects; Hearing loss; Hemorrhage; Hospitals; Humans; Hypoxia; Hypoxia, Brain - complications; Hypoxia, Brain - etiology; Hypoxia, Brain - prevention & control; Hypoxia, Brain - therapy; Impairment; Infant; Infant, Extremely Premature - growth & development; Infant, Newborn; Infants; Infants (Premature); Infrared spectroscopy; Intervention; Male; Medicine and Health Sciences; Motor ability; Near infrared radiation; Near infrared spectroscopy; Neonates; Neurodevelopment; Neurodevelopmental disorders; Neurodevelopmental Disorders - etiology; Newborn babies; Oxygenation; Paralysis; Pediatric research; People and Places; Physical examinations; Premature babies; Quartiles; Questionnaires; Research and Analysis Methods; Risk factors; Spectroscopy, Near-Infrared - methods; Standard deviation; Statistical analysis; Traumatic brain injury; Treatment Outcome; Ultrasonic imaging
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0262640

The SafeBoosC II, randomised clinical trial, showed that the burden of cerebral hypoxia was reduced with the combination of near infrared spectroscopy and a treatment guideline in extremely preterm infants during the first 72 hours after birth. We have previously reported that a high burden of cerebral hypoxia was associated with cerebral haemorrhage and EEG suppression towards the end of the 72-hour intervention period, regardless of allocation. In this study we describe the associations between the burden of cerebral hypoxia and the 2-year outcome. Cerebral oxygenation was continuously monitored from 3 to 72 hours after birth in 166 extremely preterm infants. At 2 years of age 114 of 133 surviving children participated in the follow-up program: medical examination, Bayley II or III test and the parental Ages and Stages Questionnaire. The infants were classified according to the burden of hypoxia: within the first three quartiles (n = 86, low burden) or within in the 4th quartile (n = 28, high burden). All analyses were conducted post hoc. There were no statistically significant differences between the quantitative assessments of neurodevelopment in the groups of infants with the low burden of cerebral hypoxia versus the group of infants with the high burden of cerebral hypoxia. The infants in the high hypoxia burden group had a higher-though again not statistically significant-rate of cerebral palsy (OR 2.14 (0.33-13.78)) and severe developmental impairment (OR 4.74 (0.74-30.49). The burden of cerebral hypoxia was not significantly associated with impaired 2-year neurodevelopmental outcome in this post-hoc analysis of a feasibility trial.